Provider Demographics
NPI:1669997375
Name:JEGEDE & ASSOCIATES, PLLC
Entity type:Organization
Organization Name:JEGEDE & ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ADEJOKE
Authorized Official - Middle Name:
Authorized Official - Last Name:JEGEDE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:817-600-8892
Mailing Address - Street 1:2101 SHANNON OXMOOR RD # 67
Mailing Address - Street 2:
Mailing Address - City:SHANNON
Mailing Address - State:AL
Mailing Address - Zip Code:35142-2000
Mailing Address - Country:US
Mailing Address - Phone:888-212-4243
Mailing Address - Fax:972-284-1088
Practice Address - Street 1:2311 MUSTANG DR STE 200
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-1010
Practice Address - Country:US
Practice Address - Phone:817-600-8892
Practice Address - Fax:682-503-6106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-03
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
TX34277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty